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Care in the community failures

Such patients are more likely to inflict harm - either to themselves or others - if they stop taking their medication.

Just last week an independent inquiry into a mental health patient who stabbed his girlfriend to death with scissors criticised a London health authority.

It said the authority could have done more to prevent the tragedy.

The inquiry was looking at the case of Michael Folkes, who was receiving mental health care but was released into the community.

He stabbed his girlfriend Susan Milner 70 times.

Risk

The case awakened memories of the case of Christopher Clunis, who killed Jonathan Zito on the platform of Finsbury Park tube station in north London in 1992.

Clunis had stopped taking his medication.

An inquiry placed blame throughout the system, saying that police, social workers, psychiatrists, the Crown Prosecution Service, hostel staff and probation services must all take a share.

Since then a number of high-profile murders involving care in the community patients led to Health Secretary Frank Dobson's announcement in January that the scheme was to be scrapped.

Inquiries consistently concluded that there were failures somewhere in the care system.

They included the cases of:

• Wayne Hutchinson, who was released by mistake and killed two people and injured another three in 1994;
• Stephen Laudat, who stabbed a stranger in 1994. An inquiry called for closer co-operation between local and health authorities.
• Anthony Smith, who stabbed his mother and 11-year-old half brother in 1995. A report blamed weak communications among carers;
• Gilbert Kopernik-Steckel, who twice discharged himself from hospital before stabbing his mother to death and then committing suicide in 1996. An inquiry blamed "an overwhelming failure of communications".

In 1994 the Royal College of Psychiatrists published figures showing that, in the three years previous to that, 34 people had killed someone within a year of being in contact with psychiatric services.

However, that was out of 750,000 patients who were covered by the care in the community scheme at the time.

Self-harm

Gary Hogman is head of research and communications at the National Schizophrenia Fellowship.

He said patients were more likely to inflict harm - either on themselves or others - if they stopped their medication, and that they were more likely to stop the older treatments.

He said the side-effects of the older treatments would lead to people not taking part in other therapies, which would in turn to lead to depression and feelings of despair.

In these circumstances they were more likely to stop taking their medication, he said, "which could lead to them being admitted to hospital and in the very worst cases harming themselves or others".

"The majority of homicide incidents involve people who have stopped taking their medication," he said.

"However, if you've got somebody who's harmed someone else and has stopped taking medication, then you've got another 50 or 100 who have harmed themselves.

"Underneath that you've got thousands of people who are kicking about with nothing to do because they're not getting better."

One example of a patient being failed by the system resulted in the then health secretary being called to testify in court as to why adequate care was not available.

The case occurred in February 1995 when Sharon Towes was charged with malicious wounding after a knife attack.

A bed in a psychiatric ward could not be found Ms Towes, of Crawley in West Sussex. She was schizophrenic and had erected a shrine to murder.

A judge summoned Virginia Bottomley, who was then Conservative health secretary, to appear in court to explain why a bed was unavailable.

Ms Towes later committed suicide in prison.

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National Schizophrenia Fellowship
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